THE SYPHILIS.
If the true syphilis—the variety that appeared in the fifteenth century—was unknown in the Middle Ages, there still exist documents which fully affirm the existence of contagious venereal diseases several hundreds of years before the Italian wars of Charles VIII. and Louis XII. The maladies which, in times of antiquity, afflicted the Hebrews and Romans, as a result of impure sexual commerce, are to-day only the results of the progress made by prostitution after the Crusades; that is to say, they are merely the products of debauchery and leprous virus imported from the Orient.
As early as the twelfth century France knew the mal malin or mal boubil, an affection characterized by sores and ulcerations on the arms and genital organs. Gauthier de Coinci, Prior of the Abbey of St. Medard de Soissons, at the beginning of the thirteenth century considered these maladies as impure and contagious, and warned his priests in the following verselets:
“The monk, the church clerk and the priest
Must not defile themselves the least,
But with good conscience and pure heart
Keep their hands off from private part.
Pray God at morning and at night
To hide corruption from their sight;
The mal boubil the mal malan
Comes ever to each sinning man.”
We are permitted to suppose from these lines that the disease was localized in “a wicked place that the hands must not touch,” and that it was only an affection of the same nature as the gorre and grand gorre, one of the numerous expressions applied to all contagious maladies of the sexual organs. This fact cannot be contested, for at the same epoch, in a poem entitled “Des XXIII Manieres de Vilains,” we find an imprecation launched by this anonymous author against all blackguards and bawds:
“That they may be
Itchy, poxed, and apostumed,
Covered with ulcers, badly rheumed,
Full of fever, jaundice sapped,
That they may be, also, clapped.”
Or, as given in French:
“Qu ils aient ...
Rogne, variole et apostume,
Et si aient plente de grume,
Plente de fievre et de jaunisse,
Et si aient la chade-pisse”
Now, the opuscle, from which these verses are derived, was reprinted in 1833 by Francisque Michel, and is contemporaneous with the manuscripts of the thirteenth century, analyzed by M. Littre in a note on syphilis,[31] where our erudite author says: “At this epoch the venereal diseases had an analogous form to those we observe to-day.”
This document dates back 200 years before the discovery of America, and is duly authenticated by the testimony of Guillaume Saliceti, a physician and Italian priest of the thirteenth century. “When a man has received a corruption of the penis, after having cohabited with an obscene woman or for other cause, there comes a tumor in the groin.”[32] And some years after Lanfranc, a student of Salicetis, wrote, in his turn, in his Parva Cyrurgia, that “buboes appear following ulcers on the penis.” His description of chancres and other venereal accidents is very remarkable.
Another writer of the thirteenth century, Michel Scott, a Scotch physician, alchemist, and philosopher, who lived in France and Germany for many years, says in one of his numerous works:[33] “Women become livid and have discharges. If a woman is in such a condition and a man cohabit with her his penis is easily diseased, as we often see in adolescents who, ignorant of this fact, often contract a sore organ or are attacked by leprosy. It is also well to know that if a discharge exist at the epoch of conception, the fetus is more or less diseased, and in this case a man must abstain from all connection, and the woman should resist sexual advances, if she have foresight.”
This passage leaves no possible doubt as to the existence of blenorrhagia with the discharge and as to the presence of an hereditary syphilitic diathesis, for if the author gives the last-mentioned the name of leprosy it is only for the reason that at this period no positive term was in use to designate venereal diseases,[34] which were confounded with leprosy, with or without reason, the former only being, perhaps, a transformation of the latter.
About a century later, that is to say, on August 8th, 1347, Queen Jeanne of Naples, Countess of Provence, sent to Avignon the statutes relating to the establishment of houses of prostitution in that city. Article IV. of this law regulated police measures in the following terms: “The Queen ordains that every Saturday the bailiff and a barber deputed by the Councilmen shall visit every debauched girl in the place, and if they find any one who has the disease arising from venery, that such a one may be separated from the other girls and lodged apart, to the end that no one may have commerce with her, and that the young may thus avoid contracting disease.”[35]
These statutes were first made known by Astruc,[36] and have been inserted without reserve by Grisolle in his Traite de Pathologie Interne; also by Cazenave in his Traite des Syphilides; but Jules Courtet, and after him Rabutaux and Anglada, have considered these documents as somewhat apocryphal.
We shall not stop to discuss the authenticity of these documents; they have characteristics that make their genuineness almost indisputable. Besides, we can quote other authors against whom no arguments can be used; for instance, we will cite John of Gaddesen, a physician of the English Court, who affirmed that sexual connection with a leprous woman produced ulcers of the penis;[37] besides, his compatriot Gilbert, who described in his Compendium Medicinal, in the year 1300, the treatment of gonorrhœa and chancre so common after the Crusades; or Gui du Chauliac, who in 1360 noticed “the ulcers born of commerce with a tainted woman, impure and chancrous (ex coitu cum fœtida vel immunda vel cancrosa muliere).”[38] Again, note Torella, of Italy, who considered pox as a contagious malady which had existed from times of antiquity, and which had made its appearance at different epochs, but of which the symptoms, poorly understood by medical men, prevented isolation and its proper pathological identity.[39]
We need not reproduce the text of all the French and especially the Italian doctors, who established the identity of venereal diseases before the year 1494—such writers as Montagnana, Petrus Pintor, Nicolas Leonicenus, Joseph Grunpeck, etc. As to these works, they have all been mentioned by Fracastor, in his celebrated Treatise on Contagious Diseases (de morbis contagiosis), a work at once a fine poem, whose Latinity is perfect and a monograph of true scientific exactitude.
Fracastor described the patient as well as the disease: “The victims were sad and broken with pale faces.”
“They had chancres on their private parts; these chancres were changeable; when cured at one point they reappeared at another; they always broke out again.”
“Pustules with crusts were raised on the skin; in some these commence on the scalp first; this was the usual case; in a few they appeared elsewhere. At first these were small, afterwards increasing in size, appearing like unto the milk crust in children. In some these pustules were small and dry—in others large and humid. Sometimes they were scarlet, sometimes white, sometimes hard and pink. These pustules opened at the end of some days, pouring out an incredible quantity of stinking and nasty liquid, once opened they became true phagedenic ulcers, which not only consumed the flesh but even the bone.”
“Those whose upper regions were attacked had malignant fluxions, that eat away the palate, the trachea, the throat and the tonsils. Some patients lost their lips, others their noses, others their eyes, others their private parts.”
“Large gummy tumors appeared in many and disfigured the limbs. These growths were often the size of an egg or a French roll of bread. When opened these tumors discharged a whitish mucilaginous liquid. They were principally noted on the arms and legs; while ulcerating sometimes they grew callous, at other times remaining as tumors until death.”
“As if this were not sufficient, terrible pains oftimes attacked the limbs; these generally came when the pustules appeared. These pains were long abiding and well nigh insupportable, aching most at night, not only affecting the articulation, hut also the bones and nerves of the limbs. Sometimes the patient had pustules without pains, at other times pains without pustules; but the great majority had pustules and pains.”
“The patients were plunged into a condition of languor. They became thin, weak, without appetite, sleeping not, always sad and in a sullen humor, the face and the limbs swollen, with a slight fever at times. Some suffered with pains in the head, pains of long duration, which did not recede before any remedies.”
“Although the greater majority of mortals have taken this disease by contagion, it is no less certain that a great number of others contracted it from infection. It is impossible to believe, in fact, that in such a short time the contagion that marches so slowly by itself and which is communicated with such difficulty, should overrun such a number of countries, after having been (as it is claimed), imported by a single fleet of Spanish ships. For it is well known that its existence was determined in Spain, France, Italy and Germany and all through Scythia at the same period of time. Without doubt the malady originated spontaneously, like the petechial fever, or it had always existed.”
“A barber, my friend, has a very old manuscript, containing directions for the treatment of the affection. This has for its title: ‘Medicine for the thick scabs, with pains in the joints.’ The barber remembered the remedy laid down in this work, and at the very commencement of the new malady thought he recognized the contagion by the name of the thick scabs. But physicians having examined this remedy found it too violent, inasmuch as it was composed of quicksilver and sulphur. He would have been happier had he not consulted the doctors; he would have grown wealthy by incalculable gains.”
We see from this that the syphilis of the fifteenth century did not present precisely the same symptoms as the variety of to day. Formerly secondary and tertiary accidents supervened much more rapidly, besides being very violent in their manifestations. Besides the disease was exceedingly malignant often causing, death in a short time, which fact led many authors of that epoch to consider the symptoms due to a pestilence brought about by general causes.[40] Nicholas Massa wrote in fact, that: “The patient has pains in the head, arms, and especially the legs, which are always intensified at night. The buboes in the two groins are salutary when they suppurate. We observe a chafed and scaly condition of the palms of the hands and soles of the feet. Ulcers of a bad appearance are frequently noted on the penis; these ulcers are hard and callous and very slow in healing. In exploring the throat we often discover a relaxed condition of the uvula and the presence of sordid ulcers, which rarely suppurate. With all this eruptive process we note certain hard tumors that adhere to the skin and bone and bear the name of gummata. These tumors may ulcerate and produce osseous caries.”[41]
We notice the same errors in all the descriptions given by the authors of the sixteenth century; they exhibit an imperfect knowledge of the symptomatology, of the genesis and primitive constitutional accidents. We see that as yet clinical medicine had no existence, and that our predecessors were ignorant of the art of co-ordinating the signs of a disease in a thoughtful manner. Nevertheless, their descriptive powers in writing on venereal diseases, as before noted, were excellent, and had the merit of exactitude and honest observation; as, Pierre Manardi observes: “The principal sign of the French disease consists in pustules coming out on the end of the penis in men and at the entrance of vulva or neck of womb among women. Most frequently these pustules ulcerate; I say frequently for the reason that I have seen patients in whom these ulcers were hard as warts, cloves or apple seeds.”
Here we have the aspect of primary syphilis presented by a physician whose name will, with justice, remain attached to the disease as long as it has a history. The secondary symptoms of the malady have never been more dramatically pictured than by Fernel, who remarks: “They had horrible ulcers on them, which might be mistaken for glands, judging from size and color, from which issued a foul discharge of a villainous infecting kind, enough to give a heart-ache; they had long faces of a greenish-black complexion, so covered with sores that nothing more hideous could be imagined.”[42]
Relative to the duration of secondary symptoms, under date of 1495, Marcello de Cumes wrote from the camp of Novarro that “the pustules on the face, like those of leprosy and variola, lasted a year or more when the patient was not treated.”[43]
The physiognomy of the unfortunates whose faces were adorned with lumps and whose foreheads bore the sadly characteristic corona veneris, has been well described in the following verses by Jean Lemaire, of Belgium, a poet and historical writer of fifteenth century. The portrait is exact:
“But in the end, when the venom is ripe,
Sprout out big warts of a scarlet type,
Persistent, spreading over the face,
Leaving the brand of shame and disgrace,
An injury left after passion’s rude storm,
Fair human nature thus to deform.
High forehead, neck, round chin and nose
Many a warty sore disclose;
And the venom, with deadly pain,
Runs through the system in every vein,
Causing innumerable ailments, no doubt,
From itch to the ever-tormenting gout,” etc.
Meantime, the symptoms of syphilis were not long in losing some of their acute features. Already, in 1540, Antoine Lecocq noted this fact in France:[44] “Sometimes,” says he, “the virus seems to expend its strength on the groins in tumefaction of the glands; and, if this bubo suppurates, it is well. This tumor we call bubo; others call it poulain (colt or filly) for mischief’s sake, as those who are thus attacked separate their legs while walking, horse style.” Fernel declared that the venereal disease at the end of the sixteenth century so little resembled that of his early days that he could scarcely believe it the same. He remarks: “This disease has lost much of its ferocity and acuteness.”
On his part, Fracastor remarked, in 1546, that “For six years past the malady has changed considerably. We now notice pustules on but few patients, and they have but few pains, and these are generally slight; but more gummy tumors are observed. A thing that astonishes the world is the falling out of the hair of the head and baldness in other portions of the body. It sometimes happens that in the worst cases the teeth become loose and even fall out.”[45]
These phenomena were evidently due to the action of mercurial ointment, which was much used in Italy from the time it was recommended by Hugo, of Boulogne, in the malum mortuum, or malignant leprosy of the Occident. In France guaiac was much used, or holy wood, which was then known as sanctum lignum, when only the Latin equivalent was in vogue. Besides, mention is made of mercurial stomatitis following inunctions with the so-called Neapolitain ointment in the Prologue of Pantagruel, by Rabelais.
This passage from Dr. Francis Rabelais[46] leads us to think that physicians were undecided about caring for syphilitic patients in the fifteenth century, almost all doctors, in fact, refusing to examine into the character of a disease of which they knew nothing; a disease whose infecting centers were the most degraded and ignoble public places; a malady not described in the works of Hippocrates nor Galen.
So, this lues venerea, as it is called by Fernel, made numerous victims in all countries. It spread in the towns and throughout the rural districts, and, at times, caused such ravages that, in the large cities, the authorities were obliged to use sanitary measures against the pox, as had been done at other times in the case of leprosy. Syphilitics were expelled from places and forbidden, under severe penalties, from having intercourse with healthy people. But it soon came to be known that contagion could only occur through sexual connection, and the patients then hid in hospitals, where they were specially treated by the methods laid down by the first syphilographers,—vapor baths, mercurial inunctions, frictions, etc. Unfortunately, no prophylactic measures were instituted against prostitutes, although they were recognized as having a monopoly in venereal disorders; for they did not believe at that time, like Jean de Lorme, who said: “The pox may be caught by touching an infected person; by breathing the same air; by stepping, barefooted, in the patient’s sputa, and in many other manners.”
Even the poets wrote sonnets, poems and ballads upon this mal d’amour (lovesickness). One could form an immense volume by collecting all the verses written and published on this subject during the sixteenth century. But no poem indited during that period presents so great an interest to medical science as the ballad of Jean Droyn, of Amiens, dedicated to the Prince, in which the author, stronger in the etiology of syphilis than the doctors of his time, advised young men who feared grosse verole (the pox) not to indulge in liasons with girls of the town without first being satisfied with their pathological innocence.
This ballad was published at Lyons in 1512, that is to say, seventeen years after the appearance of the disease in the army of Charles VIII., at an epoch when the majority of doctors considered the affection as an infectious malady due to the action of a pestilential miasm in the air. We shall reproduce but a few lines of this poetical-medical-historical document:
“Perfumed darlings, dandies, dudes,
Take warning in each case,
Beware all types of fleshy nudes
And don’t fall in disgrace.
Sure, gentlemen and tradesmen gay
May throw away their money,
Give banquets and at gaming play,
As flies are drawn by honey.
I warn you all of love’s sweet charms,
Place on them protocole,
For haunting oft strange women’s arms
Brings sometimes grosse verole.
“Let love, with moderation wise,
Attend each amorous feast.
Let all be clean unto your eyes,
Fly all lewd girls at least.
Happier and nobler ’tis to gain
For virtue high renown
Than wound your honor with a stain,
With women of the town.
Keep out of danger from disease,
Good health will you console,
But if you strive the flesh to please
Beware of grosse verole.”
In the final stanzas of this poem, which will not bear a more complete reproduction owing to a maudlin sentimentality existing in modern times, we find that the Prophet Job is not regarded as strictly virtuous, for we read:
“Prince, sachez que Job fut vertueux,
Mais si futil rongneux et grateleux,
Nous lui prions qu’il nous garde et console,
Pour corriger mondains luxurieux,
S’est engendree ceste grosse verole.”
Notwithstanding the undoubted proof of the antiquity of venereal diseases, Astruc, as we all know, defends the American origin of the malady, and endeavors to support his views on the hypothesis emitted by Ulrich de Hutten in 1519, i.e., at the siege of Naples, at the end of 1494, a Spanish army commanded by Gonsalva of Cordova came to the rescue of the besieged. Their soldiers communicated to the girls of the town and the courtesans of the neighborhood the maladie Americaine (American disease), which was contracted in turn, after the capture of Naples, by the army of King Charles, and afterwards spread throughout France. But history informs us that the King of France did not return to Paris with his troops from the Italian campaign until the month of March, 1496. Now it was on the 6th of March, in this same year, that Parliament issued a proclamation regulating the pox, in which the first section reads: “To-day, the 6th of March, whereas in the City of Paris a disease of a certain contagious character, known as verole (pox), prevails, the which has made much progress in the Realm the past two years, as well at Paris as in other places, and there is reason to fear, this being Springtime, that it may increase, it is deemed expedient to take cognizance of the same.”
Other testimony is gathered from the narrative of the voyages of Christopher Columbus by his contemporary Petrus Martyr, of Anghierra, historian attached to the court of Ferdinand and Isabella. According to the notes given him by the great navigator on his return to Spain, authentic records kept from day to day,[47] the Spanish and Italian sailors of Columbus found “people who lived in the Age of Gold; with no ditches, no fences, no books, no laws. The men were entirely naked, the women only protected by a belly-band of light material; notwithstanding all this, their morals were pure.” Besides, Petrus Martyr (La Syphilis au XV. Siecle) proves there was syphilis in Spain in 1487.
When Columbus returned to Europe a second time he left behind him, under orders of his brother, a hundred of his companions in arms, who were a collection of adventurers from all the nations of the earth. These men committed all sorts of excesses among the unfortunate Indians—steeping themselves in lust and every manner of crime, violating the women, and indulging in wholesale debauchery. Says Charles Renaut: “Looking at matters from this standpoint, I am ready to believe that the Spaniards carried the disease to the natives of Hispanola, and that the latter did not give the malady to the Spanish.”
We shall not dwell further on the origin of syphilis, nor its connection with leprosy and other cutaneous maladies which were so prevalent in Europe throughout the Middle Ages. We may consider the disease as something new, and trace its period of invasion and development to the discovery of America, or assert that it arose from a semi extinct affection (leprosy), assuming a new type under the influence of a special epidemic constitution.
One thing is clearly proven, i.e., that syphilis was preceded by contagious venereal affections, which lost the irregular and malignant forms of the fifteenth century. When then the civilized nations of earth create a true Public Health Service, syphilis will be vanquished, and will pass away to the ranks of other extinct maladies.